Exploring Biopsychosocial Factors Influencing the Association Between Chronic Pain and Cognitive Impairment
Philemon Domoyeri1, Pariya L Fazeli2, Prince J Mosley3
1Department of Acute, Chronic & Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
Purpose:
Chronic pain and cognitive impairment share similar biopsychosocial risk factors; however, little work has directly explored how these factors influence the relationship between chronic pain and cognitive impairment. This review aimed toexamine and integrate available evidence on biopsychosocial factors that influence the relationship between chronic pain and cognitive impairment in adults and develop a framework that will guide future research on this topic.
Design:
Integrative review.
Method:
Guided by the Whittemore and Knafl (2005) framework, we conducted a search using PubMed, Embase, and CINAHL to identify peer-reviewed, English-language articles published between 2015 and February 2025 with available full text that examined biopsychosocial factors associated with cognitive impairment in adults with chronic pain.
Results:
Thirty-one articles were included, revealing four themes: 1) nature and type of chronic pain, 2) biological aging processes, 3) psychological disturbances, and 4) socioenvironmental factors.
Conclusion:
Biopsychosocial factors influence the relationship between chronic pain and cognitive impairment through various pathways. Individuals with multifocal chronic pain, which is intense and of long duration, may be at the highest risk for cognitive impairment. Markers of brain aging and epigenetic aging may mediate the relationship between chronic pain and cognitive impairment. Psychological disturbances and the stress response may further mediate cognitive outcomes. Socioenvironmental factors may act as moderators in the relationship such that individuals with low socioeconomic status experience worse cognitive outcomes.
Nursing Practice Implication:
Cognitive assessments should be included in the routine care of individuals with chronic pain.
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